Population-based study of wake-up strokes

Jason Mackey, D. Kleindorfer, H. Sucharew, C. J. Moomaw, B. M. Kissela, K. Alwell, M. L. Flaherty, D. Woo, P. Khatri, O. Adeoye, S. Ferioli, J. C. Khoury, R. Hornung, J. P. Broderick

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Objective: Previous studies have estimated that wake-up strokes comprise 8% to 28% of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. Methods: First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. Results: We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3%) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9%) would have been eligible for thrombolysis if arrival time were not a factor. Conclusions: Within our population, approximately 14% of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.

Original languageEnglish (US)
Pages (from-to)1662-1667
Number of pages6
JournalNeurology
Volume76
Issue number19
DOIs
StatePublished - May 10 2011
Externally publishedYes

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Stroke
Population
Hospital Emergency Service
International Classification of Diseases

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Mackey, J., Kleindorfer, D., Sucharew, H., Moomaw, C. J., Kissela, B. M., Alwell, K., ... Broderick, J. P. (2011). Population-based study of wake-up strokes. Neurology, 76(19), 1662-1667. https://doi.org/10.1212/WNL.0b013e318219fb30

Population-based study of wake-up strokes. / Mackey, Jason; Kleindorfer, D.; Sucharew, H.; Moomaw, C. J.; Kissela, B. M.; Alwell, K.; Flaherty, M. L.; Woo, D.; Khatri, P.; Adeoye, O.; Ferioli, S.; Khoury, J. C.; Hornung, R.; Broderick, J. P.

In: Neurology, Vol. 76, No. 19, 10.05.2011, p. 1662-1667.

Research output: Contribution to journalArticle

Mackey, J, Kleindorfer, D, Sucharew, H, Moomaw, CJ, Kissela, BM, Alwell, K, Flaherty, ML, Woo, D, Khatri, P, Adeoye, O, Ferioli, S, Khoury, JC, Hornung, R & Broderick, JP 2011, 'Population-based study of wake-up strokes', Neurology, vol. 76, no. 19, pp. 1662-1667. https://doi.org/10.1212/WNL.0b013e318219fb30
Mackey J, Kleindorfer D, Sucharew H, Moomaw CJ, Kissela BM, Alwell K et al. Population-based study of wake-up strokes. Neurology. 2011 May 10;76(19):1662-1667. https://doi.org/10.1212/WNL.0b013e318219fb30
Mackey, Jason ; Kleindorfer, D. ; Sucharew, H. ; Moomaw, C. J. ; Kissela, B. M. ; Alwell, K. ; Flaherty, M. L. ; Woo, D. ; Khatri, P. ; Adeoye, O. ; Ferioli, S. ; Khoury, J. C. ; Hornung, R. ; Broderick, J. P. / Population-based study of wake-up strokes. In: Neurology. 2011 ; Vol. 76, No. 19. pp. 1662-1667.
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abstract = "Objective: Previous studies have estimated that wake-up strokes comprise 8{\%} to 28{\%} of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. Methods: First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. Results: We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3{\%}) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9{\%}) would have been eligible for thrombolysis if arrival time were not a factor. Conclusions: Within our population, approximately 14{\%} of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.",
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AU - Mackey, Jason

AU - Kleindorfer, D.

AU - Sucharew, H.

AU - Moomaw, C. J.

AU - Kissela, B. M.

AU - Alwell, K.

AU - Flaherty, M. L.

AU - Woo, D.

AU - Khatri, P.

AU - Adeoye, O.

AU - Ferioli, S.

AU - Khoury, J. C.

AU - Hornung, R.

AU - Broderick, J. P.

PY - 2011/5/10

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N2 - Objective: Previous studies have estimated that wake-up strokes comprise 8% to 28% of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. Methods: First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. Results: We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3%) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9%) would have been eligible for thrombolysis if arrival time were not a factor. Conclusions: Within our population, approximately 14% of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.

AB - Objective: Previous studies have estimated that wake-up strokes comprise 8% to 28% of all ischemic strokes, but these studies were either small or not population-based. We sought to establish the proportion and event rate of wake-up strokes in a large population-based study and to compare patients who awoke with stroke symptoms with those who were awake at time of onset. Methods: First-time and recurrent ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky region (population 1.3 million) in 2005 were identified using International Classification of Diseases-9 codes 430-436 and verified via study physician review. Ischemic strokes in patients aged 18 years and older presenting to an emergency department were included. Baseline characteristics were ascertained, along with discharge modified Rankin Scale scores and 90-day mortality. Results: We identified 1,854 ischemic strokes presenting to an emergency department, of which 273 (14.3%) were wake-up strokes. There were no differences between wake-up strokes and all other strokes with regard to clinical features or outcomes except for minor differences in age and baseline retrospective NIH Stroke Scale score. The adjusted wake-up stroke event rate was 26.0/100,000. Of the wake-up strokes, at least 98 (35.9%) would have been eligible for thrombolysis if arrival time were not a factor. Conclusions: Within our population, approximately 14% of ischemic strokes presenting to an emergency department were wake-up strokes. Wake-up strokes cannot be distinguished from other strokes by clinical features or outcome. We estimate that approximately 58,000 patients with wake-up strokes presented to an emergency department in the United States in 2005.

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